More will be revealed in the coming days and weeks about Tiger Woods’ condition, including his quality of life moving forward, let alone the minor question of whether he could resume his golf career at some point after a catastrophic rollover car accident.
Early Wednesday on Woods’ Twitter account was the following statement from Dr. Anish Mahajan, chief medical officer and interim chief executive of Harbor-UCLA Medical Center, describing his condition:
Mr. Woods sustained significant orthopedic injuries to his right lower extremity that were treated during emergency surgery by orthopedic trauma specialists at Harbor-UCLA Medical Center, a level 1 trauma center. Crushed open fractures affecting both the upper and lower parts of the tibia and fibular bones were stabilized by inserting a rod into the tibia.
“Additional injuries to the bones of the foot and ankle were stabilized with a combination of screws and pins. Trauma to the muscles and soft tissue of the leg required surgical loosening of the covering of the muscles to relieve the pressure from swelling. “
Dr. Kenneth Jung, an orthopedic foot and ankle surgeon, detailed that summary. Although Jung is not involved in Woods’s treatment, he spoke in general terms about the types of injuries being described, which often occur in high-energy car accidents.
That the injuries occurred to Woods’s lower right leg is not surprising, Jung said, because they usually happen when a driver hits the brake, as opposed to the left leg, which may be lying to the side. The wrecked front of the SUV Woods was driving appeared to have been compressed and collapsed by the accident.
The tibia and fibula are the two bones in your lower leg, and a crushed fracture refers to a bone being broken into multiple fragments, as opposed to a clean fracture.
The term “open” means that the bone has broken through the skin and is exposed to the outside world. That greatly increases the risk of infection, as happened with Washington Football Team quarterback Alex Smith, who suffered a horrific leg fracture that, after subsequent infections, carried the risk of amputation and was life-threatening.
“A lot of people focus on bone injuries, but that’s only part of the story,” said Jung of the Kerlan-Jobe Institute in Los Angeles. “The soft tissue envelope, or skin, is actually very important too. If you don’t have skin covering the bone, it really doesn’t matter how the bone looks or heals. “
With Woods, or anyone who has an open fracture, these first days after an accident are critical to charting the way forward.
“It is usually quite routine in the first 24 to 48 hours to return someone to the operating room to flush out the tissue, rinse the wounds again, re-inspect the tissue to see if there is necrosis or tissue death, ”said Jung.
The shin is the shin that you can feel under your skin. If wounds there are difficult to heal, doctors can use skin grafts or transfer muscles from other parts of the body to cover that bone.
In his statement on Woods, Mahajan described trauma to the muscles and soft tissue of the leg that required a “surgical release” of the fascia covering the muscles. That surgery is done to relieve the pressure that results from swelling after trauma.
“I tell patients that your muscles are actually in these compartments, almost like sausages,” Jung said. “Imagine cooking a sausage and the meat starting to expand. If you make a slit in the casing of the sausage, the meat balloons will come out. That’s similar to what they do with those sub-fund releases. “
A law enforcement officer looks over the damaged vehicle. A collision at the front of the car often results in lower leg injuries when the driver has put his foot on the brake pedal.
(Ringo HW Chiu / Associated Press)
Jung said compartment syndrome can occur almost immediately and results in uncontrollable pain.
A combination of screws and pins was used to stabilize Woods’ foot and ankle bones. While screws are most often used to fix broken bones, pins are often used to stabilize joints that may be dislocated.
Jung said a common concern is an injury to the Lisfranc joint complex in the center of the foot, which is again common in car accidents when a driver presses the brake pedal at the moment of a collision.
“Those injuries have a strong association with post-traumatic arthritis,” he said. “That would worry me not only about golf, but the future in life. That would manifest as pain and stiffness in the joints of the foot. “
Jung said even for doctors working on Woods, it’s far too premature to predict an outcome. At this point, so much depends on the skin and the occurrence of infection.
“He can have the most perfectly aligned bones. Some orthopedic surgeons have done the best job in the world to get everything aligned,” he said. “But if he got an infection unfortunately, it would all be at risk.”
The road to recovery is likely to be a long one. According to Dr. Gregory Tennant, an orthopedic surgeon at the Kaiser Permanente Medical Center in Fontana, antibiotic treatment and monitoring for infection and blood flow are usually required for the first few days after this type of injury.
In the six to nine months that follow, the focus will likely be on bone and wound healing, followed by a recovery phase of physical therapy and rehabilitation.
“I didn’t expect him to be walking around for a while,” said Tennant.
While most of the injuries described by Woods’ doctors are in his lower extremities, the golfer had recently had his fifth back surgery. It is possible that the accident will adversely affect his recovery.
“Trauma is never really an isolated event,” said Tennant. “It is not uncommon to identify injuries – even significant injuries – days later as the first high-energy injuries are dealt with.”
Ultimately, though, Tennant said Woods is in excellent hands with Harbor-UCLA, which is continually treating these types of injuries, and is optimistic about the legendary golfer’s recovery.
“Tiger Woods has been a winner all his life,” he said, “and I’ve learned that you don’t bet against winners. You don’t bet against Michael Jordan. You don’t bet against Tiger Woods.”